Adult patients with Burkitt lymphoma had survival rates higher than 90 percent after treatment with low-intensity chemotherapy regimens, according to clinical trial data published in the New England Journal of Medicine (2013;369:1915-1925).
“The outcome of high-dose regimens in adults is limited by toxicity—and low-dose regimens like R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone] have poor outcomes,” the study's senior author, Wyndham H. Wilson, MD, PhD, Head of the National Cancer Institute's Lymphoma Therapeutics Section and one of the study coauthors, said via email. “This trial tested if prolonged exposure time, rather than increased dose, would yield higher survival rates than standard treatment regimens.”
In the study (first author was Kieron Dunleavy, MD), 30 patients with previously untreated Burkitt lymphoma received the EPOCH-R chemotherapy regimen, which involves longer exposures to lower concentrations of etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (R). Nineteen patients received the dose-adjusted (DA)-EPOCH-R regimen; and 11 HIV-positive patients received the short-course (SC) EPOCH-RR regimen.
At a median follow-up of 86 months, the DA-EPOCH-R group were found to have a progression-free survival rate of 95 percent and an overall survival rate of 100 percent, which were similar to those for the SC-EPOCH-RR group—100 and 90 percent, respectively). None of the patients in either group had a recurrence of disease or died from Burkitt lymphoma. The patients' median age was 33. The principal toxicities reported were fever and neutropenia.
“The toxicity of EPOCH-R-based treatment in Burkitt lymphoma is considerably less than that reported with standard Burkitt regimens,” Wilson said. “Furthermore, these two regimens were highly effective in adult patients, who have significantly worse outcomes than children.”
He noted that the National Comprehensive Cancer Network guidelines do include the low-intensity chemotherapy regimen for treating Burkitt lymphoma in adults. But two confirmatory trials of risk-stratified treatment that are based on the SC-EPOCH-RR and DA-EPOCH-R regimens are now under way in adults (NCT01092182) and children (NCT01760226) with Burkitt lymphoma to show the regimens' higher efficacy.